Advocate for Left Atrial Appendage Occlusion (LAAO)

Dr. Mehmet Oz

Administrator

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1832-P (Proposed Rule for CY 2026 Physician Fee Schedule)

 

Re: Public Comment on Closure Left Atrial Appendage with Endocardial Implant (CPT code 33340)

 

Dear Administrator Oz:

 

I am writing to express my strong concern regarding the proposed reduction in the work Relative Value Unit (RVU) for Left Atrial Appendage Occlusion (LAAO) procedure in the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) proposed rule. I urge CMS to reconsider this reduction, which will negatively impact patient access, increase long-term costs, and undermine the delivery of high-value cardiovascular care.

 

LAAO is a proven, stroke-preventing therapy for patients with atrial fibrillation who are unable to tolerate long-term anticoagulation. These patients often have high bleeding risk and limited alternatives. By closing the left atrial appendage, the risk of clot formation — and thus disabling stroke — is substantially reduced.

 

The proposed rule would reduce the LAAO work RVU from 14.00 to 10.25 — a reduction of approximately 27%. Cumulative reductions, including the proposed efficiency adjustment and reduction to indirect practice expense for facility-based services, could result in a total RVU decrease of about 35% by CY 2027. 

 

If enacted, these cuts would:

1. Limit access for Medicare beneficiaries, which is to say those who most need this stroke-prevention option.

2. Discourage hospitals and practices from offering LAAO due to unsustainable reimbursement levels.

3. Potentially increase long-term Medicare spending from avoidable stroke hospitalizations and rehabilitation costs, thereby eliminating any potential savings.

 

The Heart Rhythm Society (HRS), American College of Cardiology (ACC), and the Society for Cardiovascular Angiography and Interventions (SCAI) have jointly stated that “cutting reimbursements for procedures that reduce strokes… will only increase the risk of hospitalization and long-term disability for vulnerable patients.” While I appreciate that the proposed rule includes a one-time conversion factor increase and other positive adjustments, those provisions will not offset the targeted and devastating reduction to this critical procedure.

 

I respectfully request that CMS:

• Maintain the current LAAO work RVU of 14.00 until a thorough and transparent revaluation process is completed.

• Consider crosswalking LAAO reimbursement to comparable, established procedures.

• Exempt LAAO from the broad efficiency adjustment, given the complexity and resource intensity of this intervention.

• Engage with professional societies to develop an evidence-based valuation that reflects actual physician work and practice expenses.

 

These proposed cuts threaten patient safety and run counter to CMS’s stated goal of improving outcomes through high-quality, value-based care. On behalf of my patients and the broader electrophysiology community, I urge you to reverse these reductions in the CY 2026 PFS final rule.

 

Thank you for considering my comment under docket CMS-1832-P.

 

Sincerely,

[Physician’s Name], [Credentials]
[Title & Affiliation]

 

References

1. ACC, HRS, SCAI Joint Statement. ACC, HRS, and SCAI Concerned by LAAO Cuts Despite Temporary Reimbursement Increases in Proposed Physician Fee Schedule. July 15, 2025.

2. Centers for Medicare & Medicaid Services. CY 2026 Physician Fee Schedule Proposed Rule (CMS-1832-P), Federal Register Public Inspection. July 15, 2025.

3. ACC. CMS Reduces LAAO Value in Proposed 2026 Physician Fee Schedule. July 15, 2025.

4. TCTMD. Some Ups, Some Downs in Proposed CMS Reimbursement for 2026, Cardiologists Say. July 16, 2025.